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drugs y3 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

How does penicillin work

A
  • has a beta-lactam ring which has anti-microbial activity
  • inhibits enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
  • weakens strength of cell wall
  • preventing them from maintain their osmotic gradient
  • causes water to move into the cell and the cell to lyse and die
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2
Q

what type of penicillin is amoxacillin

A

broad spectrum

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3
Q

what type of penicillin is co-amoxiclac

A

broad spectrum

  • used in severe, resistant hospital acquired infections
  • contains amoxicillin
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4
Q

what type of penicillin is flucloxacillin

A

penicillinase resistant penicillins

- narrow spectrum

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5
Q

what type of penicillin is benzylpenicillin

A

narrow spectrum

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6
Q

when is penicillin used

A

all types of infections

  • skin and soft tissue
  • UTRI
  • pneumonia
  • endocarditis
  • tonsilitis
  • UTI
  • H.pylori associated with PUD
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7
Q

contraindications of penicillin

A
  • allergy (always find out what type of allergy - is it just a rash or is it anaphylaxis?
  • give in caution to patients with c.difficile infections or with severe renal impairment
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8
Q

side effects of penicillin

A
  • GI upset, nausea, diarrhoea
  • allergy (can range from rash to anaphylaxis)
  • more rare: antibiotic associated colitis, acute liver injury
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9
Q

possible interactions with penicillin

A
  • can enhance anti-coag effects of warfarin

- reduces renal excretion of methotrexate so can lead to toxicity

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10
Q

how do cephalosporins work

A
  • contain a beta lactam ring
  • inhibit enzymes which are responsible for making peptidoglycans for bacterial cell walls
  • weakens strength of cell
  • preventing them from maintaining their osmotic gradient
  • water enters cells and cells lyse and die
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11
Q

examples of cephalosporins

A

cefalexin

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12
Q

are cephalosporins broad spectrum or narrow spectrum antibiotics

A

broad spectrum

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13
Q

when are cephalosporins used?

A

2nd and 3rd line in UTIs and respiratory tract infections

meningitis as can cross BBB

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14
Q

contraindications of cephalosporins

A 
- allergy
caution with:
- severe renal failure
- epilepsy
- c.difficile infection
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15
Q

side effects of cephalosporins

A
  • GI disturbance, nausea, diarrhoea
  • allergy (rash to anaphylaxis)
    more rare
  • seizure
  • antibiotic-associated colitis
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16
Q

possible interactions of cephalosporins

A
  • enhance anti-coag effects of warfarin (as of killing of normal gut flora which synthesise vitamin K)
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17
Q

how does trimethoprim work

A
  • inhibits bacterial folate synthesis
  • prevents bacteria from utilising folate for functions such as DNA synthesis
  • slows down bacterial growth and replication
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18
Q

is trimethoprim broad or narrow spectrum

A

broad yet use is decreasing due to bacterial resistance

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19
Q

contraindications of trimethoprim

A 
- first trimester of pregnancy
caution in those with...
- folate deficiency
- HIV
- elderly
- neonates
- renal impairment
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20
Q

side effects of trimethoprim

A
  • GI disturbance (N+V)
  • sore mouth
  • skin rash
  • severe hypersensitivity reactions
  • hyperkalaemia
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21
Q

possible interactions with trimethoprim

A
  • drugs which cause potassium elevation (ACEi, ARB, spironolactone)
  • drugs which increase folate metabolism (phenytoin)
  • drugs which are folate antagonists (methotrexate)
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22
Q

how does nitrofurantoin work

A
  • metabolised by bacteria cells by nitrofuran reductase
  • metabolites of this drug damage bacteria DNA
  • cause bacterial cell death
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23
Q

when is nitrofurantoin used

A

1st line for UTI

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24
Q

what bacteria does nitrofurantoin target

A
  • gram -ve e.coli

- gram +Ve staph saptophyticus

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25
contraindications for nitrofurantoin
- last trimester of pregnancy - in first 3 months of life - CKD
26
side effects of nitrofurantoin
- GI upset (diarrhoea and nausea) - hypersensitivity reactions - turns urine dark yellow, brown - less common: pneumonitis, hepatitis, peripheral neuropathy
27
possible interactions for nitrofurantoin
n/a
28
examples of tetracyclines
doxycycline, lymecycline
29
when are tetracyclines used
- acne - lower RTI such as pneumonia and infective exacerbations of COPD - chlamydial infections such as pelvic inflammatory disease - other infections such as Lyme disease, malaria, typhoid and anthrax
30
contraindications of tetracyclines
- children under 12 (causes tooth enamel hypoplasia and fluorescent yellow teeth) - pregnancy - breastfeeding
31
side effects of tetracyclines
- GI disturbance - hypersensitivity - oesophageal ulcers or dysphagia - photosensitivity - tooth enamel hyperplasia
32
possible interactions of tetracyclines
- do not give within 2hrs of calcium iron or antacids as they bind to these, thus decreasing their absorption and action
33
examples of aminoglycosides
gentamicin
34
how do aminoglycosides work
bind irreversibly to bacterial ribosomes, preventing protein synthesis
35
what type of bacteria do aminoglycosides target
- severe infections | - typically gram negative anaerobes
36
when are aminoglycosides used?
- severe sepsis of unknown cause - pyelonephritis or complicated UTI - biliary or other intra-abdominal sepsis - endocarditis
37
side effects of aminoglycosides
nephrotoxicity - accumulate in renal tubular epithelial cellss ototoxicity - accumulate in vestibular and cochlear cells
38
possible interactions of aminoglycosides
ototoxicity is more likely if given with loop diuretics
39
examples of macrolides
erythromycin, clarithromycin
40
how do macrolides work
bind to the 50s ribosome, preventing bacterial protein synthesis - bacteriostatic
41
when are macrolides used
- skin, soft tissue and respiratory infections when penicillin is contraindicated - severe pneumonia in addition to penicillin - H.pylori in addition to penicillin and a PPI
42
when are macrolides contraindicated
hypersensitivity
43
side effects of macrolides
- GI disturbance (N, V, D, abo pain) if PO - thrombophlebitis if IV - allergy - antibiotic-associated colitis - QT interval elongation, predisposing to arrythmias - cholestatic jaundice
44
possible interactions of macrolides
- other drugs which could cause arrythmias | - inhibit cytochome P540 enzymes, affecting drugs which are metabolised by these such as warfarin
45
examples of quinolones
ciprofloxacin
46
how do quinolones work
kill bacteria by inhibiting bacterial DNA synthesis | - bactericidal
47
what type of bacteria do quinolones target
mainly gram negative aerobes | - increasingly resistant
48
when are quinolones used
- mainly kept to 2nd or 3rd line due to chance of resistance - UTI - severe GI infection - only oral antibiotic which acts against Pseudomonas aeruginosa
49
when are quinolones contraindicated
caution if arrhythmias, in children or at risk of seizures
50
side effects of quinolones
- gi upset - hypersensitivity - increased risk of ruptured muscle tendons - increased risk of seizures and hallucinations - QT interval elongation
51
possible interactions with quinolones
- inhibit cytochrome p450 enzymes so increase risk of toxicity of drugs metabolised by these such as theophylline - caution with prednisolone due to risk of muscle tendon rupture - caution with NSAIDs due to increase risk of seizure - caution with drugs which may elongate QT interval
52
examples of anaerobic antimicrobials
metronidazole
53
how does metronidazole work
- taken up by bacteria - in anaerobic bacteria and is reduced to form nitroso free radical - this binds to DNA, reducing DNA synthesis - bacterial cells die - aerobic bacteria does not reduce metronidazole
54
when is metronidazole used
- anti-biotic associated colitis by gram positive anaerobic C.difficile - gynae and surgical infections (bacteria from the gut) - oral infections and aspiration pneumonia - protozoal infections
55
when is metronidazole contraindicated
alcohol
56
side effects of metronidazole
- GI upset - hypersensitivity - at high dose, peripheral and optic neuropathy, seizures, encephalopathy
57
possible interactions of metronidazole
- lithium toxicity - inhibits cytochrome P450 inhibitors - enhance cytochrome P450 inducers
58
examples of glycopeptides
vancomycin
59
what does vancomycin target
mainly gram positive bacteria | - gram negative bacteria have slightly different cell wall structures
60
how does vancomycin work
inhibits cross linking and enzymes in peptidoglycan bacterial cell wall synthesis - weakens structure of cell - water enters, cell lyses and dies - bacteriostatic
61
when is vancomycin contraindicated
caution in elderly or renal impairment
62
side effects of vancomycin
- thrombophlebitis at infusion site - 'red man syndrome' (generalised erythema) - IV rarer: nephrotoxicity, ototoxicity, neutropenia, thrombocytopenia
63
when is vancomycin used
- 2nd line in antibiotic associated colitis | - gram positive infections if severe or penicillin contraindicated - such as endocarditis
64
possible interactions with vancomycin
drugs which can also induce nephrotoxicity or ototoxicity

drugs y3 (10 decks)

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